Dr. Marc Sicklick of Lawrence Shares Covid-19 Vaccine Updates

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Dear Residents:

In response to inquiries regarding the vaccines currently available to combat the Covid-19 pandemic, we have asked Lawrence resident Dr. Marc Sicklick, noted immunologist, to share his expertise and insights with our community. We thank him and trust you will find the following of value.

Thank you,

Alex H. Edelman
Mayor


Marc J. Sicklick, M.D.
Allergy, Asthma, and Immunology

January 26, 2021

The two vaccines currently on the market remain the Pfizer and Moderna products. Both require two doses in order to maximize the benefit and to be fully effective. The minimum recommended window between the doses is 3 weeks for the Pfizer and 4 weeks for the Moderna, and the maximum protection should be reached within two weeks after the second dose. No matter what you read in newspapers about politicians wanting to stretch the interval or to only give one dose for now, the FDA has only approved the two dose regimen.

The medical goal remains to fully vaccinate as many people as possible in as short of time as possible. It needs to be done both safely and in a manner that maximizes the immune response.

The state and NYC governments have discussed the release of doses that were, until now, being held for the second dose in order to maximize the number of available first doses. This is only being done because the supply lines seem ready to produce enough to not delay the second dose, but I worry that this may not be correct and some second doses may be delayed. No one has proof that delaying the second dose is not scientifically wrong for the reasons I list just below.

There will definitely be delays in first doses and appointments will be cancelled when the roll out doesn’t meet the demand. It’s difficult to know the reality of potential supply/production given the horrible roll out and political agendas of all sides. I do expect emergency approval of the one shot Johnson and Johnson vaccine to happen soon and this will greatly increase available vaccine, especially given the increasing production of the present vaccines. (President Biden has set a goal of 1 million doses/day. We are currently up to about 1.1 million doses/day.) (The Johnson and Johnson vaccine is much easier to store and I expect it to be available in doctor’s offices.)

Remember- the second Moderna and Pfizer shots are important and necessary.

1) The duration of one shot immunity is just not known.

2) 90-95% immunity is the potential benefit of the two shot regimen and some studies show as little as 33% benefit from one shot.

3) One shot will give a false sense of security/immunity to many people, will probably change behavior, and may lead to more illness and death.

4) Will less immunity in some way impact virus mutation?

5) The bottleneck seems to be much more distribution related than production related.

Finally, the basic arithmetic of one shot protection should be examined. If 100 people get the two shot regimen and it has 95% protection, that could potentially lead to 5 cases per 100 people. If we only give one shot and can now vaccinate 200 people at 50% efficacy, that will leave 100 people vulnerable using the same amount of vaccine. The one shot J&J vaccine, when released, should quickly increase accessibility and end this discussion.

The distribution system has been less than optimal. The initial access was through hospital systems. Their employees were, by and large, first on line and I understand this. They provided the staffing and the physical space and needed to protect these people. But this left non-hospital affiliated doctors hanging for weeks. The fear of these first line practitioners was real and very palpable.

Now, as non-health workers become eligible, the issue seems to be scheduling appointments. It is very difficult and very, very frustrating, especially for older people who are not computer savvy. The response to a horrible web site for enrollment was for the State to separate its enrollment website from the other distributors’ websites and to make everyone spend hours cruising the internet hoping to find a magical moment of success.

Mayor Alex Edelman, Village Administrator Ron Goldman, and Deputy Administrator Gerry Castro have offered the Lawrence Yacht and Country Club for use as a POD (Point of Distribution) for vaccine administration for those legally entitled to receive the vaccine. Many residents have volunteered to join the Nassau County Medical Reserve Corps to help administer the vaccine. Yet the offer, as of today, has not been accepted. They have all been working very hard to get this local Point of Distribution approved.

Changing topics, what about the stories of anaphylaxis to the vaccine?

To date, I am not aware of any allergic fatalities. The incidence of reported reactions is very, very low and new data keeps changing the results. It seems to be about 5 times the risk of a flu shot reaction, but again, that is low. The current FDA numbers put the incidence of anaphylaxis to the Pfizer vaccine at 0.001%, although from experience in local hospital networks it may be as high as 0.005%. The true rate is unclear at this time. Anyone can have an allergic reaction to anything and it would not surprise me to see a higher rate. If you have allergies, discuss it with your allergist.

There are testing protocols being developed for people with possible allergic reactions to the first dose. These involve testing with other drugs that contain the suspected allergens, such as depomedrol for a suspected PEG trigger and kenalog or hepatitis A vaccine for a suspected polysorbate reaction. Unfortunately, due to scarcity, there is no extra vaccine available for direct testing of the vaccine.

If you suspect that you had an allergic reaction to the first dose, discuss it with your allergist before getting the second dose.

Israel, which is far ahead of the rest of the world in vaccinating its population, is primarily using the Pfizer vaccine. They submit data to Pfizer daily and are the largest clinical “lab” being used now. They report an adverse reaction rate (that’s all significant reactions, not just allergies) to the vaccine of 0.06% And they are now vaccinating down to age 16.

People who have had recent COVID seem to have at least transient immunity. Current guidelines put that at 90 days and it seems likely that this will be extended to 180 days. If you have previously been infected, before receiving the vaccine, the timing of the vaccine needs to be discussed with your physician. It may be that early administration is not needed.

Finally, if you’re sick, get tested and confer with your doctor. There are therapeutic modalities that are significantly beneficial that need to be administered within a certain time window. If you tough it out until you’re vey sick, you can miss the window.

A last point. What is the natural course of the COVID 19 pandemic?

It is a roller coaster pattern. The number of those infected goes up and down depending on the season, parties, the number of vulnerable people exposed, travel, and many other factors that we don’t yet know. The drop off in the latter part of last spring and the return in the fall were all predicted.

We are currently at a peak of infections. The deaths will still climb into February. Although the effect of travel during the current local school intersession is a potential negative factor, it still appears that the number of cases will be decreasing over the next few months. Hopefully, between this natural cycle and the increasing availability of vaccines, herd immunity is attainable.

Sincerely yours,

Marc J. Sicklick, M.D.



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